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Research ArticleLumbar Spine

Ligamentum Flavum Cyst With Acute Onset Motor Deficit: A Literature Review and Case Series

KALYAN KUMAR VARMA KALIDINDI, MOHD RAFIQ BHAT, MAYANK GUPTA, ABHISHEK MANNEM and HARVINDER SINGH CHHABRA
International Journal of Spine Surgery August 2020, 14 (4) 544-551; DOI: https://doi.org/10.14444/7072
KALYAN KUMAR VARMA KALIDINDI
Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India
MS DNB
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MOHD RAFIQ BHAT
Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India
MS
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MAYANK GUPTA
Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India
MS DNB
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ABHISHEK MANNEM
Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India
MS DNB
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HARVINDER SINGH CHHABRA
Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India
MS
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    Figure 1

    Case 1. (a, b) Sagittal T1- and T2-weighted magnetic resonance images of the patient showing a lesion hypointense on T1 and hyperintense on T2 within the posterior spinal canal at the L4–L5 level compressing the thecal sac (marked with blue arrow). (c, d) Axial T1- and T2-weighted MRI image at the L4–L5 level of the patient showing a lesion with hypointense signal (similar to cerebrospinal fluid signal) on T1 imaging and hyperintense signal on T2 imaging in the midline and slightly to the left (marked with blue arrow). (e, f) Anteroposterior and lateral x-rays of the lumbosacral spine of the patient showing degenerative changes at the L4–L5 and L5–S1 levels. Grade 1 spondylolisthesis at L5–S1 can be appreciated on the lateral view.

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    Figure 2

    Case 1. (a, b) Postoperative anteroposterior and lateral x-rays of the patient showing posterior instrumentation from L4 to S1 and transforaminal lumbar interbody fusion at the L5–S1 level. (c) Image showing the excised ligamentum flavum cyst measuring about 1 cm in length. (d) Histopathological slide of the cyst shows a cystic lesion lined by a fibro-connective tissue with mild chronic inflammatory infiltrate and fibroblast proliferation. Few proliferating blood vessels are seen. There is no lining epithelium, consistent with a ligamentum flavum cyst.

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    Figure 3

    Case 2. (a, b) Sagittal T1- and T2-weighted magnetic resonance images of the patient showing a lesion hyperintense on T2 and hypointense on T1 at the L4–L5 level within the posterior spinal canal compressing the thecal sac (marked with blue arrow). (c, d) Axial T1- and T2-weighted magnetic resonance images at the L4–L5 level of the patient showing a lesion with hypointense signal (similar to cerebrospinal fluid signal) on T1 and hyperintense on T2 in the midline (marked with blue arrow) compressing the thecal sac.

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    Figure 4

    Case 2. (a, b) Postoperative anteroposterior and lateral x-rays of the patient showing posterior instrumentation from L4 to S1 with accurately placed screws. (c) Specimen showing the excised laminae (marked with white arrow) along with ligamentum flavum (marked with yellow arrow) en masse. The ligamentum flavum cyst (marked with blue arrow) can be clearly seen on the inner surface of the ligamentum flavum. (d) Histopathological slide of the cyst showing fibro-elastic tissue with chondroid metaplasia and areas of calcification. There is no lining epithelium, consistent with a ligamentum flavum cyst.

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International Journal of Spine Surgery
Vol. 14, Issue 4
1 Aug 2020
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Ligamentum Flavum Cyst With Acute Onset Motor Deficit: A Literature Review and Case Series
KALYAN KUMAR VARMA KALIDINDI, MOHD RAFIQ BHAT, MAYANK GUPTA, ABHISHEK MANNEM, HARVINDER SINGH CHHABRA
International Journal of Spine Surgery Aug 2020, 14 (4) 544-551; DOI: 10.14444/7072

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Ligamentum Flavum Cyst With Acute Onset Motor Deficit: A Literature Review and Case Series
KALYAN KUMAR VARMA KALIDINDI, MOHD RAFIQ BHAT, MAYANK GUPTA, ABHISHEK MANNEM, HARVINDER SINGH CHHABRA
International Journal of Spine Surgery Aug 2020, 14 (4) 544-551; DOI: 10.14444/7072
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Keywords

  • lumbar spine
  • ligamentum flavum cyst
  • acute onset neurologic deficit
  • cyst excision and confirmed on histopathology
  • literature review and case series

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